Role of gastric bypass in patients with unresectable advanced carcinoma of stomach.

Context: Role of bypass as a palliative surgery for advanced gastric cancer remains controversial.

Aims: To determine the role of bypass in advanced gastric cancer in comparision to resection as gold standard.

Design: Hospital-based retrospective outcome as study.

Methods: Patients were divided into three groups: group I (gastric resection), group II (bypass) and group III (exploratory laparotomy alone). The three groups were analysed for palliation of symptoms, operative morbidity and mortality and survival.

Statistical Analysis Used: Chi-square, Fischer, One-way Anova, Unpaired-t, Kaplan-Meier analysis.

Results: In-hospital morbidity was 19.38% (19 patients) for the entire study group. Bypass group had a lower morbidity rate as compared to the resection group (p=0.029). In-hospital mortality rate was 6.12% (6 patients) for the entire study group. Mortality rates did not differ between the groups. Patient satisfaction with palliation of symptoms was similar between gastric bypass and resection. Gastric resection group had significantly better survival (p=0.002) compared to the nonresective procedures. However, gastric bypass did not confer any survival benefit over exploratory laparotomy (p=0.501).

Conclusions: Gastric bypass can be done when resection is not possible as it palliates symptoms on par with resection and is associated with low operative morbidity though it does not improve the survival outlook of patients.